Buccal midazolam: Are we ready yet?

Klimach et al. make a strong case for the use of buccal midazolam (BM) in the community. In our district general hospital at Queen’s Hospital, Burton on Trent we introduced BM in 2006 for the management of prolonged seizures. Parents and carers are advised and trained to administer the drug for out of hospital use. BM is prescribed as a take home medication with an information leaflet to assist parents/carers. We carried out a survey recently to assess the awareness and estimate experience in its use as well as satisfaction of healthcare professionals and parents with BM. Of 134 questionnaires returned and analysed—53 parents, 81 health care professionals took part. Only 34% of parents or carers were aware of or educated to use BM. But 78% of parents familiar with BMhad administered it. All the users reported a high degree of satisfaction in administration aswell as effectiveness of BM. Seizure control was achieved in 88% of cases after the first dose with no severe adverse effects. Our study highlights the lack of awareness of BM amongst parents and carers (34%). Despite the reduced awareness, majority of parents who were made aware used the drug and were highly satisfied with its administration and efficacy. Randomized multicentre controlled trials comparing BM with rectal diazepam have established its safety, efficacy as well as superiority or comparable effectiveness. Klimach et al. with their manuscript have now closed the void of lack of data in the community. Despite these studies the awareness amongst parents and carers is not satisfactory resulting in reduced use and minimal benefit to patients. From our experience awareness needs to be augmented amongst parents and carers and paramedical personnel. This will aid in reducing the duration of seizure and make management easier, both in and out of hospital setting. Regular educational sessions and incorporating the use of BM into local, regional and national guidelines will ensure its effective implementation in practice.